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Background: Previous studies have suggested an association between reasoning strategies and diagnostic success, but the influence on this relationship of variables such as question format and task difficulty, has not been studied. Our objective was to study the association between question format, task difficulty, reasoning strategies and diagnostic success. Methods: Study participants were 13 Internal Medicine residents at the University of Calgary. Each was given eight problem-solving questions in four clinical presentations and were randomized to groups that differed only in the question format, such that a question presented as short answer (SA) to the first group was presented as extended matching (EM) to the second group. There were equal numbers of SA/EM questions and straightforward/difficult tasks. Participants performed think-aloud during diagnostic reasoning. Data were analyzed using multiple logistic regression. Results: Question format was associated with reasoning strategies; hypothetico-deductive reasoning being used more frequently on EM questions and scheme-inductive reasoning on SA questions. For SA question, non-analytic reasoning alone was used more frequently to answer straightforward cases than difficult cases, whereas for EM questions no such association was observed. EM format and straightforward task increased the odds of diagnostic success, whereas hypothetico-deductive reasoning was associated with reduced odds of success. Conclusions: Question format and task difficulty both influence diagnostic reasoning strategies and studies that examine the effect of reasoning strategies on diagnostic success should control for these effects. Further studies are needed to investigate the effect of reasoning strategies on performance of different groups of learners.

Background: Resident evaluation is a complex and challenging task, and little is known about what assessment methods, predominate within or across specialties. Aims: To determine the methods program directors in Canada use to assess residents and their perceptions of how evaluation could be improved. Methods: We conducted a web-based survey of program directors from The Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited training programs, to examine the use of the In-Training Evaluation Report (ITER), the use of non-ITER tools and program directors' perceived needs for improvement in evaluation methods. Results: One hundred forty-nine of the eligible 280 program directors participated in the survey. ITERs were used by all but one program. Of the non-ITER tools, multiple choice questions (71.8%) and oral examinations (85.9%) were most utilized, whereas essays (11.4%) and simulations (28.2%) were least used across all specialties. Surgical specialties had significantly higher multiple choice questions and logbook utilization, whereas medical specialties were significantly more likely to include Objective Stuctured Clinical Examinations (OSCEs). Program directors expressed a strong need for national collaboration between programs within a specialty to improve the resident evaluation processes. Conclusions: Program directors use a variety of methods to assess trainees. They continue to rely heavily on the ITER, but are using other tools. [ABSTRACT FROM AUTHOR]

Context The Royal College of Physicians and Surgeons of Canada (RCPSC) CanMEDS framework is being incorporated into specialty education worldwide. However, the literature on how to evaluate trainees in the CanMEDS competencies remains sparse. Objectives The goals of this study were to examine the assessment tools used and programme directors’ perceptions of how well they evaluate performance of the CanMEDS roles in Canadian postgraduate training programmes. Methods We conducted a web-based survey of programme directors of RCPSC-accredited training programmes. The survey consisted of two questions. Question 1 was designed to establish which assessment tools were used to assess each of the CanMEDS roles. Question 2 was intended to assess programme directors’ perceived satisfaction with CanMEDS evaluation in their programmes. Results A total of 149 of the eligible 280 programme directors participated in the survey. Programme directors used a variety of assessment tools to evaluate trainees in CanMEDS competencies. Programmes used more tools to evaluate the Medical Expert (mean = 4.03, standard deviation [SD] = 1.59) and Communicator (mean = 2.36, SD = 1.02) roles. Programme directors used the fewest tools for the Collaborator (mean = 1.75, SD = 1.10) and Manager (mean = 1.75, SD = 1.18) roles. More than 92% of the programmes used in-training evaluation reports to evaluate all the CanMEDS roles. Programme directors were satisfied with their evaluation of the Medical Expert role, but less so with assessment of the other CanMEDS competencies. Conclusions This study demonstrates that Canadian postgraduate training programmes use a variety of assessment tools to evaluate the CanMEDS competencies. Programme directors are neutral or concerned about how the CanMEDS roles other than that of Medical Expert are evaluated in their programmes. Further efforts are required to establish best practice in CanMEDS evaluation. [ABSTRACT FROM AUTHOR]

Background: Racial differences in health outcomes in general are well documented; however, few studies examined the impact of East Asian and Indo Asian race on choice of dialytic modality and survival among patients with end-stage renal disease (ESRD)., Methods: We compared the use of peritoneal dialysis (PD) and survival among East Asian, Indo Asian, and white patients with ESRD initiating dialysis therapy in Canada between January 1, 1990, and December 31, 2000., Results: Of 10,338 patients, 5.7% were East Asian, 3.2% were Indo Asian, and 91% were white. After controlling for sociodemographics and comorbidities, East Asian and Indo Asian patients were significantly more likely to initiate dialysis therapy on PD compared with white patients (odds ratio, 1.63; 95% confidence interval [CI], 1.36 to 1.96; odds ratio, 1.52; 95% CI, 1.21 to 1.93, respectively), with no difference in likelihood of technique failure. East Asian and Indo Asian patients had a lower risk for death after the initiation of dialysis therapy (irrespective of modality) compared with white patients, with adjusted hazard ratios of 0.66 (95% CI, 0.58 to 0.76) for East Asian patients and 0.63 (95% CI, 0.53 to 0.75) for Indo Asian patients. The survival benefit for East Asian and Indo Asian patients was similar in the subgroup that initiated dialysis therapy with PD., Conclusion: We found that Asian patients with ESRD were more likely to initiate dialysis therapy using PD, with improved survival after the initiation of dialysis therapy, compared with white patients. Elucidation of factors in East Asian and Indo Asian ESRD populations that result in improved outcomes may have implications for ESRD treatment for other racial groups.

Registry data report racial differences in hemodialysis (HD) care, with ethnic minorities at a disadvantage. However, little information is available regarding Aboriginal HD patients specifically. This study sought to compare the quality of HD care between Aboriginal and non-Aboriginal patients in Canada. All adults who were established on HD for > or = 6 mo in a single Canadian province were included. Clinical information was obtained by patient interview and chart review, with race determined by self-report. Quality of HD care was assessed by small solute clearance, BP control, mineral metabolism, and anemia management. Of the 835 patients, 95 (11.4%) were Aboriginal. Aboriginal patients were significantly younger, were more likely to have diabetes as the cause of ESRD, and had a higher degree of comorbidity than non-Aboriginal patients. There were no differences between Aboriginal and non-Aboriginal patients for small solute clearance, anemia management, or use of permanent vascular access. Aboriginal patients, however, were less likely to achieve a target predialysis systolic BP of < 140 mmHg (29.5 versus 44.9%; P = 0.004), a target phosphate level of < 1.8 mmol/L (40.0 versus 67.3%; P < 0.0001), and a calcium-phosphate product < 4.4 mmol2/L2 (52.6 versus 72.7%; P < 0.001). Quality of care was found to be similar for Aboriginal compared with non-Aboriginal HD patients except for differences in predialysis systolic BP and mineral metabolism, which may be influenced by individual and cultural factors. Explanations for these differences and their impact on morbidity and mortality warrant further investigation.